E-Journal Faculty of Medicine Universitas Padjadjaran / E-Jurnal Fakultas Kedokteran Universitas Padjadjaran
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Profil Morbiditas dan Mortalitas Layanan Anestesi dan Pembedahan Pasien Geriatri di RSUP Dr. Hasan Sadikin Bandung Periode Februari sampai April Tahun 2021
Get PDFPasien geriatri dapat meningkatkan angka kejadian morbiditas dan mortalitas saat mendapat tindakan anestesi dan pembedahan. Tujuan penelitian adalah mengetahui profil morbiditas dan mortalitas layanan anestesi dan pembedahan pasien geriatri di RSUP Dr. Hasan Sadikin periode Februari–April tahun 2021. Penelitian ini merupakan penelitian deskriptif observasional secara retrospektif terhadap rekam medis pasien yang mendapat tindakan anestesi di kamar operasi RSUP Dr. Hasan Sadikin Bandung pada bulan Februari–April tahun 2021. Hasil penelitian didapatkan karakteristik pasien dengan rerata usia 66 tahun, jenis kelamin laki-laki 51,0 %, IMT normal sebanyak 51,7%, status non covid 100%, komorbiditas hipertensi 30,2%, operasi elektif sebanyak 86,5%. Jenis tindakan operasi terbanyak dari bagian bedah digestif sebanyak 28,9%, status ASA 2 sebanyak 79,2%, dan tindakan anestesi umum sebanyak 69,8%. Simpulan, angka kejadian morbiditas dan mortalitas layanan anestesi dan pembedahan pasien geriatri di RSUP Dr. Hasan Sadikin bulan Februari sampai April 2021 didapatkan morbiditas sebanyak 105 pasien (70,4%) dan mortalitas sebanyak 10 pasien (6,7%). Morbiditas dan mortalitas terbanyak ditemukan pada wanita, 18,5–24,9 kg/m2 komorbid hipertensi, operasi emergensi, ASA ≥3, dan anestesi umum. Peningkatan angka keberhasilan kesehatan ditandai dengan adanya peningkatan presentasi populasi geriatri. Konsekuensinya peningkatan angka ini akan diikuti oleh peningkatan angka operasi dan tindakan anestesi. Pasien geriatri diketahui dapat meningkatkan angka kejadian morbiditas dan mortalitas dengan mendapat tindakan anestesi dan pembedahan. Kombinasi beberapa faktor yaitu status kesehatan, status nutrisi, komorbiditas, tipe pembedahan, status fisik ASA dan tipe anetesi akan berpengaruh. Tujuan penelitian adalah mengetahui profil morbiditas dan mortalitas layanan anestesi dan pembedahan pasien geriatri di RSUP Dr. Hasan Sadikin Periode Februari sampai April Tahun 2021. Penelitian ini merupakan penelitian deskriptif observasional secara retrospektif terhadap rekam medis pasien yang mendapat tindakan anestesi di kamar operasi RSUP Dr. Hasan Sadikin Bandung pada bulan Februari sampai April tahun 2021. Data berdasarkan kondisi pasien, tindakan operasi, status ASA, tindakan anestesi, kejadian intraoperasi, komplikasi di ruang pemulihan dan ruang rawat biasa serta ruang semiintensif/intensif serta mortalitas, data tersebut dicatat dan diolah. Hasil penelitian didapatkan karakteristik pasien dengan rata-rata usia 66 tahun, jenis kelamin laki-laki 51,0 %, IMT normal sebanyak 51,7%, status non covid 100%, komorbiditas hipertensi 30,2%, operasi elektif sebanyak 86,5%. Jenis tindakan operasi terbanyak dari bagian bedah digestif sebanyak 28,9%, status ASA 2 sebanyak 79,2% dan tindakan anestesi umum sebanyak 69,8%. Simpulan pada penelitian ini angka kejadian morbiditas dan mortalitas layanan anestesi dan pembedahan pasien geriatri di RSUP Dr. Hasan Sadikin bulan Februari sampai April 2021 didapatkan morbiditas sebanyak 105 pasien (70,4%) dan mortalitas sebanyak 10 pasien (6,7%). Morbiditas dan mortalitas terbanyak ditemukan pada golongan jenis kelamin wanita, IMT 25,0 – 29,9, komorbid hipertensi, operasi emergensi, ASA ≥ 3 dan anestesi umum
Paradoxical Hemiparesis from Cerebellopontine Angle Tumor: A Case Report
Get PDFObjective: To report a vestibular schwannoma in the cerebellopontine angle presenting with paradoxical hemiparesis with the Kernohan-Woltman Notch Phenomenon (KWNP).Methods: A 31-year-old female presented to the neurology clinic at Bhayangkara Hospital TK. I R. Said Sukanto, Indonesia, on 29 November 2021 with loss of balance, hearing, vision, and weakness in her left arm and leg. On physical examination, the patient had reduced left arm and leg muscle strengths against resistance (MRC grade 4), face deviation to the left, abnormal finger-to-nose test, dysdiadochokinesia, and inability to perform tandem gait. She was admitted for a brain MRI but did not return to the hospital for re-evaluation and surgery. Results: The brain MRI showed a mass on the left side of the cerebellum with a size of 4.44x3.93x4.93 cm, suggesting vestibular schwannoma. The mass also caused the obliteration of the ventricle, causing hydrocephalus.Conclusion:KWNP is an unusual finding resulting in a paradoxical hemiparesis, a false-localizing neurologic sign. Physicians should recognize KWNP in patients with hemiparesis, especially in space-occupying lesions. Imaging studies can help localize the lesion to minimize misdiagnosis and optimize patient treatment.
Correlation Between Pre-Chemotherapy AMH Level, Menstrual Status, and Prediction of Ovarian Function Recovery after FAC Chemotherapy AMH in Breast Cancer Patients
Get PDFAround 52.6% of women aged <50 years in Indonesia are diagnosed with breast cancer. One of the chemotherapy regimens with a toxicity effect on reproductive function, especially ovarian follicles, is 5-fluorouracil-doxorubicin-cyclophosphamide (FAC). Anti-Mullerian Hormone (AMH) is a biomarker that can be used to assess the ovarian function. This study aimed to determine the correlation between pre-chemotherapy AMH serum level, menstrual status, and whether the AMH serum level can predict ovarian function recovery in pre-menopausal women receiving FAC chemotherapy. This was an analytical observational study with a prospective cohort design performed in Dr. Hasan Sadikin General Hospital, Bandung, Indonesia, during 2021-2022. Data were analyzed using correlation analysis. Subjects were breast cancer patients aged ≤45 years, still of reproductive age, with no prior history of chemotherapy, and were undergoing the FAC chemotherapy. All 32 patients who met the inclusion criteria were included in this study. There was a significant difference (p 0.0001) between pre- and post-6 cycles of chemotherapy AMH levels. Post-6 cycles of chemotherapy showed lower AMH levels. There was a high correlation (p 0.0034) between pre-chemotherapy AMH level and menstrual status six months after six cycles of chemotherapy. The correlation test between post-chemotherapy AMH level and menstrual status showed a non-significant result. Thus, there is a high statistical correlation between pre-chemotherapy anti-Mullerian hormone levels in pre-menopausal women with breast cancer and the menstrual status after FAC chemotherapy which demonstrates that the AMH level could also be used to predict ovarian function recovery
Correlation Between P-Selectin Level and Platelet Aggregation in Cerebral Venous Sinus Thrombosis Patients
Get PDFOne of the causes of cerebral venous sinus thrombosis (CVST) is platelet hyperactivity. Adhesion and secretion are the beginning of platelet activation, which is indicated by a change in the Platelet-selectin (P-selectin) level. The end result of platelet activation is platelet aggregation. However, it is unknown whether the beginning of platelet activation ends with platelet aggregation. This study aimed to discover the correlation between P-selectin level and platelet aggregation in CVST. This study used a cross-sectional escriptive observational correlative approach. Subjects were the CVST outpatients visiting the Neurology Department of Dr. Hasan Sadikin General Hospital, Bandung, Indonesia, from July to September 2021. A total of 49 subjects met the inclusion and exclusion criteria. This study used citrate plasma samples for platelet aggregation and serum for P-selectin assessment. Platelet aggregation were assessed using the light transmission platelet aggregation method while P-selectin was assessed using Enzyme-linked immunosorbent assay (ELISA). Platelet aggregation median was 10.6% (range 0.2–82.4%), which reflected normoaggregation. Platelet hyperaggregation were seen in 9 samples (8.4%). Median of P-selectin was 2.4 ng/mL (range 0.1–10.1 ng/mL) which were normal. High P-selectin level was observed in 16 (32.7%) with 4/16 (25%) experiencing platelet hyperaggregation. Statistical analysis showed a weak negative correlation between P-selectin and platelet aggregation (r=-0.012; p=0.467). In conclusion, no correlation is seen between P-selectin and platelet aggregation, which may be due to the fact that platelets are influenced by many factors that are not examined in this study
Pregnant Human Myometrial 1-41 Cell Viability Test on Vitamin D Administration
Get PDFBackground: Preterm labor is one of the universal causes of perinatal mortality worldwide. One of the causes of preterm labor is uterine muscle integrity problems. Some mechanistic studies show insight into vitamin D activity’s possible role in the injured muscle. This study aimed to determine whether vitamin D can increase muscle cell viability.Methods: This experimental research used human smooth muscle uterine myometrium cell line pregnant human myometrial (PHM) 1-41. The cells were cultured for 24 hours in hypoxia condition, then incubated with several doses of vitamin D. The PHM1-41 cell viability was measured using spectrophotometry. Data analysis was conducted using IBM SPSS 24.0. A p-value <0.05 was considered statistically significant. Results: The result showed that the minimum level of muscle cell viability after vitamin D incubation was with 300 nM administration, and the maximum level was after 10nM (88.57%+4.48 and 96.21%+2.13 respectively).Conclusions: Vitamin D at a specific dose can improve cell availability. The optimal dose to improve cell viability is 10 nM.
Gambaran Mortalitas dan Morbiditas Pasien Bedah Elektif di RSUP Dr. Hasan Sadikin Bandung Ditinjau Berdasarkan Skor American Society of Anesthesiologists-Physical Status (ASA-PS)
Get PDFPeningkatan kapasitas tindakan pembedahan tidak terlepas dari risiko mortalitas dan morbiditas yang meningkat. Sistem klasifikasi American Society of Anesthesiologists-Physical Status (ASA-PS) merupakan salah satu alat evaluasi pasien sebelum operasi yang dianggap mudah, akurat, dan komprehensif untuk memprediksi luaran pascaoperasi. Penelitian ini dilakukan dengan tujuan mengetahui gambaran mortalitas dan morbiditas pasien bedah yang ditinjau berdasarkan skor ASA-PS. Penelitian dilakukan dengan metode deskriptif dari data rekam medis pasien bedah elektif di RSUP Dr. Hasan Sadikin periode 2019−2022. Jumlah mortalitas dan morbiditas pada periode penelitian ini sebanyak 29 dan 25 kasus dan selanjutnya dikelompokan berdasarkan usia. Departemen obstetri dan ginekologi menjadi departemen tertinggi pada kedua kasus mortalitas dan morbiditas. Mortalitas tertinggi terjadi pada subjek dengan skor ASA-PS II (48,27%), diikuti oleh ASA III (31,03%), dan IV (20,68%), dan umumnya terjadi pascaoperasi. Morbiditas tertinggi juga terjadi pada subjek dengan skor ASA-PS II yaitu sebesar 64%, diikuti ASA-PS III sebesar 28%. Penyebab morbiditas subjek beragam pada berbagai sistem organ. Berdasarkan hasil penelitian, dapat disimpulkan mortalitas dan morbiditas didominasi oleh pasien dengan skor ASA-PS II dan umumnya disebabkan oleh henti jantung dan syok, baik intraoperatif maupun pascaoperasi. Peningkatan kapasitas tindakan pembedahan tidak terlepas dari meningkatnya risiko mortalitas dan morbiditas. Sistem klasifikasi American Society of Anesthesiologists-Physical Status (ASA-PS) merupakan salah satu alat evaluasi pasien sebelum operasi yang dianggap mudah, akurat, dan komprehensif untuk memprediksi luaran pascaoperasi. Penelitian ini dilakukan dengan tujuan mengetahui gambaran mortalitas dan morbiditas pasien bedah yang ditinjau berdasarkan skor ASA-PS. Penelitian dilakukan dengan metode deskriptif dari data rekam medis pasien bedah elektif di RSUP Dr. Hasan Sadikin periode 2019-2022. Jumlah mortalitas dan morbiditas pada periode penelitian ini sebanyak 29 dan 25 kasus dan selanjutnya dikelompokan berdasarkan usia. Departemen obstetri dan ginekologi menjadi departemen tertinggi pada kedua kasus mortalitas dan morbiditas. Mortalitas tertinggi terjadi pada subjek dengan skor ASA-PS II (48,27%), diikuti oleh ASA III (31,03%), dan IV (20,68%), dan umumnya terjadi pascaoperasi. Morbiditas tertinggi juga terjadi pada subjek dengan skor ASA-PS II yaitu sebesar 64%, diikuti ASA-PS III sebesar 28%. Penyebab morbiditas subjek beragam pada berbagai sistem organ. Berdasarkan hasil penelitian, dapat disimpulkan mortalitas dan morbiditas didominasi oleh pasien dengan skor ASA-PS II dan umumnya disebabkan oleh henti jantung dan syok, baik intra operatif maupun pascaoperasi
Giant Pyonephrosis Due to Calculus of Ureter: A Case Report
Get PDFGiant pyonephrosis (GP) is a rare and severe form of pyonephrosis characterized by a massive enlargement of the affected kidney due to the accumulation of infected fluid. This study presents case of a 51-year-old male patient with giant pyonephrosis who underwent nephrectomy as treatment. The clinical manifestations of giant pyonephrosis are nonspecific, necessitating the use of imaging and laboratory techniques to aid in diagnosis. Nephrectomy is the preferred treatment option for these patients. One week after nephrectomy, the laboratory results showed improvements. Making the right treatment decision is challenging in this particular case
Relationship between Age, Exercise Habits, Cigarette Smoke Duration Exposure, and Lung Vital Capacity in Passive Smokers
Get PDFLung vital capacity of is different for each individual depending on personal characteristics, such as age, body mass index (BMI), and exercise habits or environmental factors, such as exposure to cigarette smoke. This study aimed to determine the relationship between personal characteristics, duration of exposure to cigarette smoke, and lung vital capacity in passive smokers in one of the areas in Indonesia. This study was a cross-sectional observational analytic study conducted during the period of August to September 2019. Data were collected through interviews and measurements using the Contec SP10BT spirometer. Participants were sampled consecutively with only women who did not smoke but had at least one family member who actively smoked and was over 20 years old participated in this study. Women were selected as the population due to the fact that the proportion of passive smokers among women is higher than men, while the age group of above 20 years old was selected with a consideration of the average age for the optimum lung capacity. The relationship between personal characteristics and a history of exposure to cigarette smoke with lung vital capacity was analyzed using Pearson and Spearman correlation test. There is a significant relationship between age, exercise habits, duration of exposure to cigarette smoke, and vital lung capacity (p=0.000; p=0.018; p=0.000) among the participants of the study. However, further research is still needed to be able to generalize this finding into a broader community
Effect of Community Education on Community Knowledge of Premature Rupture of Membranes
Get PDFPremature rupture of membranes (PROM) is still a health problem with a reasonably high incidence among pregnant women in Indonesia. The PROM is defined as the rupture of membranes before signs of labor are observed. Better knowledge on the causes, signs, symptoms, and complications of PROM is believed to help in reducing maternal and infant mortality caused by PROM. This was a cross-sectional, analytic observational study conducted in Cipacing Village, Sumedang, West Java, Indonesia during the period of June–July 2022. Community education was held to give better knowledge about PROM for women with an obstetric and gynecology specialist and fetomaternal consultant as the resource person. Total sampling was obtained from 62 women. Data were collection using pre-test and post-tests before and after the education session. The mean pre-test score was 6.48, while the mean post-test score was 7.96. A dependent T-test was used to determine the relationship between scores before and after the community education with a p-value of 0.0001. There was a significant increase in knowledge about PROM after the education session compared to before the session. This means community education is effective and impactful to increase the level of knowledge about PROM among women
Hepatoprotective Potentials of Dates Extract (Phoenix dactylifera) in Acetaminophen-Induced Mice
Get PDFDates (Phoenix dactylifera) are considered as a well-known fruit consumed by many people in various countries. This study aimed to examine potential effects of dates as a hepatoprotective agent in mice. This study was conducted at the Iratco Group’s eLRosa Laboratory Research Facility, Indonesia, starting from June 2022 to July 2022. Mice from ddY strain were randomly divided into 5 groups (n=5 per group) of positive and negative control groups, and treatment groups 1, 2, and 3. The negative control group as the normal baseline did not receive acetaminophen and date extract. In treatment groups, 30 µL/30 gr BW, 60 µL/30 gr BW, and 100 µL/30 gr BW extract was given per oral to Treatment Group 1, Group 2, and Group 3, respectively for 20 days. On day 21, all treatment groups were induced with 300mg/KgBW acetaminophen for 3 days via the intraperitoneal route. Blood tests were performed on day 24 to measure the serum transaminase level as the parameter of liver damage. The lowest level of transaminase serum was found in group 3 with the highest volume of dates extract, which was 100 µL, followed by group 2 (60 µL), and group 1 (30 µL). There was a significant difference between the positive control group and treatment groups with no significant difference was seen between negative and the treatment groups. This study concludes that dates extract has the potential of being a hepatoprotective agent